Medical Specialties

As a runner, I am often accused of being a masochist or at least having masochistic tendencies. Given that I routinely subject myself to pain and recently wrote an essay about running and freedom that was rather pain focused, this is hardly surprising. Other runners, especially those masochistic ultra-marathon runners, are also commonly accused of masochism.

In some cases, the accusation is made in jest or at least not seriously. That is, the person making it is not actually claiming that runners derive pleasure (perhaps even sexual gratification) their pain. What seems to be going on is merely the observation that runners do things that clearly hurt and that make little sense to many folks. However, some folks do regard runners as masochists in the strict sense of the term. Being a runner and a philosopher, I find this a bit interesting—especially when I am the one being accused of being a masochist.

It is worth noting that I claim that people accuse runners of being masochists with some seriousness. While some people say runners are masochists in jest or with some respect for the toughness of runners, it is sometimes presented as an actual accusation: that there is something mentally wrong with runners and that when they run they are engaged in deviant behavior. While runners do like to joke about being odd and different, I think we generally prefer to not be seen as actually mentally ill or as engaging in deviant behavior. After all, that would indicate that we are doing something wrong—which I believe is (usually) not the case. Based on my experience over years of running and meeting thousands of runners, I think that runners are generally not masochists.

Given that runners engage in some rather painful activities (such as speed work and racing marathons) and that they often just run on despite injuries, it is tempting to believe that runners are really masochists and that I am in denial about the deviant nature of runners.

While this does have some appeal, it rests on a confusion about masochism in regards to matters of means and ends. For the masochist, pain is a means to the end of pleasure. That is, the masochist does not seek pain for the sake of pain, but seeks pain to achieve pleasure. However, there is a special connection between the means of pain and the end of pleasure: for the masochist, the pleasure generated specifically by pain is the pleasure that is desired. While a masochist can get pleasure by other means (such as drugs or cake), it is the desire for pleasure caused by pain that defines the masochist. As such, the pain is not an optional matter—mere pleasure is not the end, but pleasure caused by pain.

This is rather different from those who endure pain as part of achieving an end, be that end pleasure or some other end. For those who endure pain to achieve an end, the pain can be seen as part of the means or, perhaps more accurately, as an effect of the means. It is valuing the end that causes the person to endure the pain to achieve the end—the pain is not sought out as being the “proper cause” of the end. In the case of the masochist, the pain is not endured to achieve an end—it is the “proper cause” of the end, which is pleasure.

In the case of running, runners typically regard pain as something to be endured as part of the process of achieving the desired ends, such as fitness or victory. However, runners generally prefer to avoid pain when they can. For example, while I will endure pain to run a good race, I prefer running well with as little pain as possible. To use an analogy, a person will put up with the unpleasant aspects of a job in order to make money—but they would certainly prefer to have as little unpleasantness as possible. After all, she is in it for the money, not the unpleasant experiences of work. Likewise, a runner is typically running for some other end (or ends) than hurting herself. It just so happens that achieving that end (or ends) requires doing things that cause pain.

In my essay on running and freedom, I described how I endured the pain in my leg while running the Tallahassee Half Marathon. If I were a masochist, experiencing pleasure by means of that pain would have been my primary end. However, my primary end was to run the half marathon well and the pain was actually an obstacle to that end. As such, I would have been glad to have had a painless start and I was pleased when the pain diminished. I enjoy the running and I do actually enjoy overcoming pain, but I do not enjoy the pain itself—hence the aspirin and Icy Hot in my medicine cabinet.

While I cannot speak for all runners, my experience has been that runners do not run for pain, they run despite the pain. Thus, we are not masochists. We might, however, show some poor judgment when it comes to pain and injury—but that is another matter.

One specific health care problem is the shortage of primary care physicians. There are various reasons why fewer people are deciding to be primary care physicians, but the one that is most often cited is the matter of money. While a primary care physician can make a good living, their income will generally be less than a specialist. Of course, it is not just a matter of money: some people decide to be specialists because of the challenge, out of personal interest in the area, or out of pride. But money seems to be a rather important factor.

There have been various attempts and proposals to address this matter. One approach is to increase the number of primary care physicians by providing financial incentives, such as support during medical school in return for a period of community service. There have been even better financial deals proposed, but the basic idea behind them all is increasing the number of physicians via the use of government subsidies. On the plus side, this would result in an increase in the number of such doctors (but the exact impact is still unclear). On the minus side, the money has to come from the tax payers (or China).

Another suggested approach is to allow nurses and other medical professionals who are not doctors step into the role of providing such care. In many cases, this sort of things is already being done to a degree. For example, when I had my quadriceps tendon repaired, almost all my follow up was with nurses and physician assistants. On the plus side, it is easier (and cheaper) to train people for these roles relative to what it costs to train a full doctor. Also, there would presumably be a larger pool of people willing and able to fill these roles. There is also the fact that much of the needed care does not actually require the training or skills of an actual doctor. As such, this could be a practical way to fill in the gaps in medical care. On the minus side, there is the concern that while such people could fill in many gaps, there would still be important gaps left unfilled that would still require an actual doctor. However, it seems likely that could addressed as well.

Because I have written some posts critical of the current economic system I have been accused of envy and jealousy.

Like most people, I do not think of myself as being envious. However, I could be wrong about this. As such, I’ll take the time to consider this charge.

The charge of jealousy can be easily dismissed. Strictly speaking, jealousy is based on a fear of loss to another. Since I do not fear that I will lose what little I have to the rich, I am not jealous of them. However, the charge of envy requires a bit more work.

To start my rely, I need a definition of “envy.” Since I am a philosopher, I’ll consider two definitions put forth by better thinkers than I. Aristotle regarded envy “as the pain caused by the good fortune of others.” Kant, ever the wordy fellow, took it to be “a reluctance to see our own well-being overshadowed by another’s because the standard we use to see how well off we are is not the intrinsic worth of our own well-being but how it compares with that of others.”

For the sake of brevity, I’ll go with Aristotle’s definition.

As far as I can tell, the good fortune of those who are rich does not cause me any pain. My writings also do not seem to show that I feel pain at such good fortune. In fact, years of athletic competition have taught me to think well of those who succeed through just means in difficult endeavors. I have run with (or rather far behind) elite athletes and do not feel any pain at their success. Rather, I am impressed with their talent and training and wish them well. I would, of course, like to be as good as they are and this does cause me some pain-namely the pain of working those hills and doing what I rather dislike: running round and round a track as fast as a I can.

As far as I can tell, I feel the same about the rich who have earned their wealth through fair means and in the face of challenges. Artists, writers, athletes, inventors, business folks and so on who have started from little (or nothing) and have earned top spots in the income brackets have not my envy, but my respect and admiration. Those who started with much, but have done great things also are not victims of any envy on my part. As with running, people who are out ahead of me via hard work and just efforts only motivate me.

I am, of course, critical of what strikes me as unfair, unjust, harmful, unethical or otherwise bad. To stick with the running analogy, if I criticize a runner who wins by using performance enhancing chemicals that are banned, I hardly seem to be envious. A better explanation, given my established character, is that I am against such cheating. Likewise, if I am critical of some aspect of the economic system that involves deceit, bribery, law breaking, or something that is harmful to the general good, then it seems most reasonable to attribute my motivation to being concerned about matters of ethics and justice rather than to accuse me of the base motivation of envy.

It might be wondered what would count as evidence of envy. Could I not be hiding bitter envy behind a cloak of alleged virtue?

That is, of course, a reasonable challenge. After all, who would admit to being motivated by envy, prejudice, greed or other such base emotions? Do we not all dress up our ugly emotions in finery so that the appear things of beauty and loveliness?

Of course we do. It would be an error to think otherwise. However, it is also an error to assume that what lies behind someone you disagree with is a base emotion as a motivation. To assume that I am critical of economic injustices because I am secretly enraged by my lack of a yacht, mansions, billions and bling would equally be an error. This would be on par with assuming that a person is against taxes because he is motivated merely by greed or that someone is pro-defense because she is motivated by a lust for bloodshed.

To fairly accuse someone of such a base motivation would require adequate evidence.

One rather decisive indicator of envy would require that I become rich. If my behavior and writing did not change, then it would seem odd to attribute what I do to envy. After all, I would have no reason to be envious then. Of course, as I am not devoted to becoming rich, this shall only happen by chance and thus is rather unlikely.

A less clear indicator is, of course, the content what I actually write and my behavior. One can go through it and look for signs that I feel pain at the good fortune of the rich. For example, if I merely lashed out at the rich without any foundation beyond my wanting their money and not having it, then that would provide some evidence. If, however, I were to present considered arguments and take into account opposing views, then it would be rather hard to take that as evidence of envy-unless, of course, any criticism of anything counts as envy.

As another example, if I were regularly engaged in activities that were clearly aimed at being rich or otherwise showed clear signs that what I truly valued was being rich, then there would be at least some foundation for a claim of envy. Since my chosen profession is professor of philosophy and my other interests are not money focused (running, gaming, writing unpaid blogs, and so on) it would seem odd to claim that I am money focused. While I am no genius, I did very well in college and was able to get a PhD from Ohio State. As such, I think it is reasonable to infer that I could have been a success in another far more lucrative field if money was, in fact, my consuming focus. As far as the stock charge that professors are only professor because they could not hack it outside of the ivory tower, the burden of proof is on those who make the charge. In any case, anyone who knows me well knows that I could hack it just fine.

Of course, what would also be needed is evidence that I feel pain at my lack of adequate success in money making endeavors and this pain is caused by the success of others (and not merely the pain of failure). That evidence also seems to be sorely lacking.

As such, I would infer that I am not envious of the rich. I am, however, critical of certain practices, laws and individuals. Naturally, I am open to evidence that I am deluding myself, that I am, in fact, full of repressed envy of the rich.